New CAC-DAD Score Outperforms Agatston Score in Predicting Cardiac Events, Study Finds

The following were the key findings of the study:

• During the median follow-up of 30 days, 61 patients experienced major adverse cardiovascular events (MACE), including nonfatal myocardial infarction and cardiovascular death.
• A high CAC-DAD score (≥2050) identified 74% of MACE cases, compared to 57% identified by an Agatston score (AS) ≥400.
• Univariable analysis showed that elevated CAC-DAD scores, higher AS thresholds, older age, diabetes, hypertension, and statin use were linked to increased MACE risk.
• In multivariable analysis, only the CAC-DAD score (hazard ratio: 2.57), along with age, diabetes, and statin use, remained statistically significant predictors of MACE.
• Adding the CAC-DAD score to a predictive model containing demographic variables and the Agatston score improved the model’s accuracy, increasing the C-statistic from 0.61 to 0.66.

The findings suggest that the CAC-DAD score may offer a more refined tool for assessing cardiovascular risk, especially in patients who might appear lower risk based on traditional calcium scoring alone. The study authors highlighted that individuals with a high CAC-DAD score, even if their Agatston score is low, may still face elevated risk and should be considered for more aggressive preventive strategies.

Overall, the study supports the integration of advanced automated imaging metrics into clinical practice to enhance cardiovascular risk stratification and guide more tailored treatment approaches.

Reference:

Huangfu G, Ihdayhid AR, Kwok S, et al. Novel CAC dispersion and density score to predict myocardial infarction and cardiovascular mortality. Circ Cardiovasc Imaging. 2025;18:e018059.